Healthcare Provider Details

I. General information

NPI: 1912855131
Provider Name (Legal Business Name): TRACI DODD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 2ND ST STE 200
SAND SPRINGS OK
74063-7628
US

IV. Provider business mailing address

3640 EVANS AVE
MANNFORD OK
74044-3158
US

V. Phone/Fax

Practice location:
  • Phone: 918-641-4462
  • Fax:
Mailing address:
  • Phone: 918-855-0722
  • Fax: 918-855-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number206765
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: